Increasing Frailty Predicts Worse Outcomes Following Angiogram-Negative Subarachnoid Hemorrhages
Chirag Gandhi, Christian Bowers
Introduction: Angiogram-negative subarachnoid hemorrhages (ANSAH) have a reduced incidence of rebleeding and higher rate of good outcomes than aneurysmal SAH, but the effect of frailty on patient outcomes is unknown.
Objective: We investigate the impact of frailty on outcomes, in-hospital complications, and mortality in patients with ANSAH utilizing the Modified Frailty Index (mFI).
Methods: Patients with non-traumatic SAH and negative cerebral angiograms after vascular hemorrhage were identified from 2014 to 2018. The cohort was divided into non-frail (mFI=0) and frail (mFI≥1) groups based on pre-hemorrhage characteristics. Primary outcomes were mortality rate and discharge location. Multivariate analyses determined predictors of ANSAH severity. Receiver operating characteristic (ROC) curves and areas under the curve (AUC) were used to discriminate risks for those who were likely to receive an extra-ventricular drain (EVD), expire during the stay, and be discharged home.
Results: 75 patients with a mean age of 55.4±1.5 years, comprised of 42 (56%) females, and 41 (54.7%) with perimesencephalic bleeds (PMH-SAH). A total of 43/75 (57.3%) patients were non-frail and 32/75 (42.7%) were frail. Frail individuals were 6.2 times less likely to be discharged home (OR=0.16; 95% CI: 0.05-0.5; P=0.0009), and all mortalities occurred in frail patients (12.5% [n=4/32]; P=0.0296). The only independent predictor of mortality was higher mFI (OR=5.4; 95% CI: 1.5-19.1; P=0.009), while lower mFI best predicted discharge home (OR=0.39;95% CI: 0.17-0.88P=0.023). ROC analysis showed that mFI best predicted both mortality (AUC=0.9718; P=0.0016) and discharge home (AUC=0.7998; P<0.0001).
Conclusions: Independent of age, frail ANSAH patients have worse presentations, more complications, poorer outcomes, and increased mortality compared to non-frail patients.